The closure ends MSF’s four-year stint in the Bajaur region of the Federally Administered Tribal Areas (FATA), where healthcare access is limited, and hits 120 staff working there.

The move comes seven weeks after the medical charity was ordered to shut down two health facilities it ran for 14 years in the nearby Kurram district, plagued by militancy over the past decade.

“Healthcare services are very limited in the area and most of our patients cannot afford to pay even for basic medical care,” Azaad Alessandro Alocco, the group’s representative in Pakistan, said in a statement.

“As the only major hospital providing free, quality healthcare in the area, the closure of MSF’s activities will leave a major gap and have serious negative implications for the health of people living in Bajaur.”

No reason was given for the closure order, it added.

Foreign nationals and groups working in the sensitive region, plagued by some of Pakistan’s poorest healthcare and lowest literacy rates, require no-objection certificates from the government, but their renewal has been denied to MSF.

The interior ministry, responsible for the issue of the documents, did not respond to a Reuters’ request for comment.

Large swaths of land in the region have been ravaged by militant groups battling Pakistan’s army for the better part of a decade. The conflict left tens of thousands homeless and devastated education, health and housing facilities.

Pakistani NGOs and journalists also face restrictions when working in the tribal regions. Security concerns have prompted stiffer conditions in recent years for aid and research organizations that seek permits to work there.